What You Should Have Been Paid (ft. Xinan Rahman)

0:00you know, the average profit margin of health systems is just slightly over 0%. With the roads to underpayments and contracts specifically, health systems lose 1% to 3% annually on underpayments specifically. What I found from talking to folks, it's not that staff aren't competent, staff in revenue cycle, they're extremely competent. Really, the challenge is the volume of underpayments that happen. The gap really is having technology that allows you to catch that underpayment. We're able to identify, hey, like was this the right amount according to the contract that should have been paid? Welcome to Digital Voices, we're health care and life science leaders explore the real work behind transformation. This podcast is about people, leadership and the conversations that move health care forward. Now you're host Ed Marx. Welcome to another edition of Digital Voices. Thank you for tuning in and listening and watching.

1:04We are at our 3 million now load. Super excited. I know that you have a lot of choices and what you watch, listen to you and you've chosen Digital Voices and we will make it worth your while. So today I have my friend, Zinan Rahman, he's the CEO founder of Cisara Health. Zinan, welcome to Digital Voices. Yeah, thank you for having me. It's great to be here. No, it's gonna be great because I love founder stories, people who are really trying to make a difference and it's always interesting to hear about your journeys because other people inside of health care, they may have the same sort of desire to do what you've done and do something transformative and they're always like, wow, I wonder how that person did it. I wonder what they're like and you know, is that something that I can do. You first came to me that your name because I heard from other people some of the great work that you're doing and I'm like, I gotta meet this person and hear more about it. So we connected and had some lengthy conversations. Zinan, but the most important thing that we probably talk about in our podcast is what's on your playlist? What songs do you like to listen to? Yeah, no, that's a

2:07great question. So for me, it's a variety, honestly. I think I have a very diverse taste and nowadays, generally, I'm listening to a lot of nostalgic music. So for me, nostalgic, you know, like anything from 90s or 80s rock to, you know, I actually watched the greatest showman recently for the first time a few months ago and that playlist has been on repeat for me. So songs like Million Dreams and then Tightrope by Michelle Williams. I also just really admire Hugh Jackman as a vocalist as well as an actor. So yeah, that's one playlist that's been on repeat for me. Yeah, that's very cool. I like that. What about life message and montraurs or words that you live by? Some words or phrases that kind of guide your life? Just keep going and have fun.

3:13One thing I've learned throughout the experiences I've had is that, you know, like everyone, everyone says that life is just ups and downs and you just have to keep going. So that's something I personally being honest with yourself, especially about what you want because I think for a lot of people, if you're really ambitious about what you want to achieve and you have a high bar for yourself, sometimes you can sort of forget about what you personally are honestly feeling like and how that relates to what you want to achieve. So yeah, I think honesty with yourself most importantly and then just keep going and have fun. Yeah, no, I like that. Those are good good words to live by. So you got the coolest name of anyone ever on the podcast before and spell for those who don't know, spell X, I, and that is so cool. I wish I had a they've like that.

4:14So tell us your story. Like where are you from and how do you get to work? So well, I'll start with the story of my name. So I'm originally from Bangladesh and I grew up in Bangladesh and my dad, you know, he's the type of person and I get a little bit of this from him. He likes doing things that he he perceives as other people thinking to be unique. So that came with how he named me and my sister. So Zanon is an Arabic. It's an Arabic name and technically like phonetically, it should be spelled with a Z. But my dad, he was like, my kids, they're going to be special, unique, whatever. So that's where he decided, okay, I'm going to just spell it with an X. And here we are. My my sister's name is Zara actually. And her name is also spelled with an X. You know, my dad, he was an entrepreneur as well. So he grew up in rural Bangladesh. He was the

5:18youngest son of seven kids, I believe. And my dad, he was, you know, whenever I catch up with my uncles, cousins from the dad from my dad's side of family, they tell me that he was the type of kid growing up where, you know, my paternal grandparents, they didn't do very well growing up. So my dad, you know, he was very studious and he would cry all the time when my grandparents unfortunately couldn't afford all of the books that he wanted for school. So, you know, he did very well academically, got scholarships to go down into the city. He was also, you know, very entrepreneurial. He encountered tragedy quite early. His dad, my paternal grandfather passed away when he was a junior in university. And so since, you know, he was one of the first to go to university out of his family, he sort of had the pressure to, pressure to provide for the seven other kids,

6:20started a business in Bangladesh doing garments and clothing. You know, that's the equivalent of the dot com boom in Bangladesh a few decades ago. Yeah, like I think for him, education was always a priority. So that's something he prioritized with me and my sister and I. And I think, throughout my childhood, expectations were always pretty high. And the bar was pretty high in terms of what he expected that his kids would achieve both academically and beyond. So I would say, I had a good childhood in the sense that, you know, I think I really got the ambition that I have from my dad and how he sort of raised us. And, you know, I had a great time. I went to an international school in Bangladesh, grew up with folks from all over the world. Funnily enough, there's actually a Korean diaspora in Bangladesh. So a lot of my best friends growing up are Korean. Yeah, I had a

7:25great time. I went to I came to the U.S. when I was 18 for universities. So I went to Johns Hopkins. That was also, you know, some of the best years of my life so far. In college, you know, like I knew I wanted to do something entrepreneurial down the line. I didn't really know when. In terms of academics, you know, I was interested in both the humanities and mathematics, but growing up. But then I also got a little bit of practicality for my dad. And in my head, I was like, okay, if I wanted to build something, build a company down the line, I should just study computer science because hey, what better way to learn how to do things? You know, had the privilege of working at both startups and then big tech companies, working at big tech companies, I sort of realized, okay, I definitely want to go the smaller company around at least at the beginning. And coming out of college,

8:31one sort of pivotal moment in my life, I think, was the decision to start a company with three of my buddies from college. We were in, you know, the similar organizations and were very good friends. All of us wanted to start a company someday. We were talking to a friend of ours who worked at Deloitte and did enterprise software implementations. And he was complaining about how implementations took so long. It, you know, like it takes years for the average epic implementation to go live, right? So that's where we sort of stumbled into the world of implementation. And we realized talking to a bunch of leaders at system integrators that this takes really a really long time. And there's this opportunity for AI and agents to come in and really accelerate the timeline for software implementations. So we started that company, you know, went through

9:34why combinator scaled it to 40 or so people in a couple of years. And yeah, we were back to by Sequoia at our seed and then RA. And I can definitely go into specifics, but it was a great ride. I had a great time. And I think some of the implementations that our customers did were actually, you know, healthcare specific implementations. So that's sort of where I got to see on the ground level some of the problems that led me to this company. Yeah, before we go there, what about your sisters? Did they make it? Did they come to the United States as well? Or did they stay back? They came over as well? Yeah, very cool. And yeah, that's an awesome story. I know how your parents, you know, gave you that, but all of your sisters and yourself that that opportunity and to do well. And then when you were working with your last company, I'm just curious. Like as

10:40just like a general example, so if a if a typical, let's just say, epic implementation of mind take 18 months, what would be like, would you cut it in half by 25%? I'm just curious. Because I think we're here to write or probably like, Oh, well, that's pretty interesting. Yeah, totally. So across our customers, what we would see is that, you know, like our wedge into sort of the implementation, end to end implementation process was the requirements gathering piece, which is, you know, anywhere between the first three to six months of an implementation. And what we would see is using our platform where we would consolidate all historical data of past implementations, the current state of the software that's being implemented, the business processes, etc. We'd see over 50% increase. In some cases, up to 70 80 in terms of the amount of time that went in. Yeah, because, you know, I just have to smile because how many implementations I've been through in

11:43my career and it's always this cookie cutter approach. And they people just tell you and you accept it as gospel. Hey, it's going to take six months for this, six months for this. And pretty soon, like the 18 months, it's like, how in the world take that long. So I was like, man, where were you when I was doing all these implementations? I'm kind of upset now. But that, yeah. So how long were you there creating the company? And then when you exited, how long was that period? Yeah, yeah. So that was a few years. So I would say just about two years there. And yeah, I think we had the luck and privilege of growing really fast. I think what happened was that the problem that we were solving around implementations taking so long and system integrators, you know, you're deloitte or your mid market epic partner, for example, they were feeling a little bit of an

12:45existential sort of feel with AI, like, you know, implementations. The status quo is time and materials. Yeah. But now AI comes along, Palantir is already doing outcome based. And it's like, wow, our entire business is about to change and we need to get ahead. So that sort of existential feeling, I think really allowed us to come in and provide value to our customers quickly. And yeah, like we grew to, you know, we're pushing 40 people right now. And on my end, you know, the four founders and I like all of us were technical. So we did both engineering and sales. And then I realized, wow, like go to market is something I enjoy went there, skilled the team a bit. And then I switched post sales. So being in the trenches of doing our own implementations for our customers to ultimately help them. So yeah, it was a great experience, you know, just learning how to

13:48manage your team as we're growing so fast, hiring great folks from places like Palantir and other companies. So all right. So this all led you into healthcare because you got this exposure on these, you know, cutting these implementation times way down. And then you started Cesaro. So tell us the origin story, like how did this start? Like you were seeing, I'm guessing that you were seeing these critical issues with underpayments that is happening in healthcare. It's actually a series of moments that led me to really gaining conviction around this problem area of underpayments and just healthcare billing as a whole. Some of that came from the experience I had at Octor talking to other founder friends and executives in healthcare while I was there. And the other piece is, you know, I remember while I was in college reading my EOBs for, you know, when I hurt my knee and I was a bit confused. I remember I was looking at the final bill and the final bill,

14:54even though my net patient responsibility was the same according to my insurance policy, the amount that the insurer apparently reimbursed was lower than what the health system or healthcare provider had charged. Now, you know, in some cases, the bill charges are obviously different from the contracted rate in some cases. Moments like those made me continuously extremely curious. And I started talking with executives and leaders in the space. And I sort of realized that, hey, like, you know, with the roads to underpayments and contract specifically, health systems lose one to three percent annually on underpayments specifically. And yeah, like the status quo, the current macro environment with the rate of denials just increasing. What I found from talking to folks was that it's not that staff aren't competent. Staff

15:56in revenue cycle, they're extremely competent. They're very hard workers. Really, the challenge is the volume of underpayments that happen. And the gap really is having technology that allows you to catch that underpayment, not six months after the fact when you finally have the downtime to review. But instantly, right? So going to Cesaro, what we do is we all contracts that might sit in Epic. It might be in SharePoint. It might be somewhere else. We unify that. And then we look at all of the remitances as they come in. So 835s. And we're able to identify, instantly, hey, like, was this the right amount according to the contract that should have been paid? So that's sort of what we do in terms of the outcomes that we offer. We are

17:00with partners that we work with. Well, we're sort of able to do since we've rebuilt the infrastructure from the ground up to do this. We're able to identify over 90 percent of valid underpayments. So over 90 percent of that one to three percent benchmark. And of that 90 percent, we're able to recover over 70 percent. And that's just in the pilot. So if we scope it to a specific service line, and long term, we run a program to sort of transform that and get to 100 percent because ideally, these are just contracted rates. You should be able to know as a remitance comes in, hey, how much should I have been paid and runner recovery workflow, autonomously? Yeah, that's amazing. Almost too good to be true to sort of thing because as we know in healthcare right now, and we are recording in fall of 2026, you know, the average profit margin of health systems is just slightly over 0 percent, like like a half percent. Profits

18:05obviously, there's some that do much better, 5 to 10 percent, but they're in the minority. And there's many that run under zero, right? They're in the rear. And so you would immediately be able to bring them up quite substantially. So it's pretty amazing. What are you most excited about? So there's this big launch event, right? Tell us about what's happening here in early October. Yeah, totally. So we are doing a launch, some more investors, early investors, including Y Combinator, they will be launching us in the coming week or so. So we're very excited about that. We're very excited to this date. We've been pretty quote unquote stealthy, like, you know, we're in with our early partners, etc. But we're excited to sort of finally unveil the work that we've been doing. And it'll be good. It'll be good. I'm just really excited to show everyone what we've been working on.

19:06No, it is really exciting. Like I said, I mean, I work with health systems all the time. It's just a struggle financially and kind of losing though, you know, if we called it AI wars with payers, kind of losing a little bit. And I think just something that'll help definitely equalize things. If not, give providers, you know, a little bit more of an offensive weapon to make sure they're getting paid what they're both to get paid. So for those watching visually, I'm recording from my home. And so one of our dogs has jumped on our lap. So you're watching visually. That's what you see. She decided to make a cameo. So the other thing what I found super interesting is tell us the name, like, how did you come up with the name for your company? For me, I really like having some sort of implied meaning or some sort of hidden meaning whenever I like with regards to names, especially Cesara is actually a reference to Cesaria, Mazzacca, which is a ancient Byzantine city in

20:09present day Turkey. So it was Capodokia back then. And that's where back in the day, Saint Basil of Cesaria, he founded the first sort of health system ever. So that's where the name comes from. No, I love it. It goes back. I think part of what your your father gave to you in terms of uniqueness, right? And thinking of something. What comes after? I you know, you mentioned, the focus right now is recovery on underpayments, which is something happening at one to three percent. What else is on a road map? So let's just say you have a health system client. They're doing really good. Thanks to your system. What's next? What can they expect next? What else are you getting to attack? Yeah, yeah, totally. So in terms of what we offer, an interesting place to start is the contracts themselves, right? These contracts, they sort of govern the payments and

21:12money that flows through between a health system and a pair. And here, what we're really trying to do is sort of transform the entire process. So we eventually get to that end state of, hey, when a patient comes in, we're able to sort of as quickly as possible, understand, hey, like for these procedures, this is the right amount that should be paid. And it's a seamless process. So to sort of get there, the next few things that we offer are, you know, not only underpayments, but going upstream into pre-belling, denials, etc. But also more downstream. So, you know, when when you're able to accurately identify, hey, this is the right amount to be paid, giving patient cost estimates are seamless as well. You're able to give a more effective and accurate good faith estimate there as well. You're hitting the most painful parts first, which I think is very clever.

22:16Tell us about your go-to-market strategy. What sort of unique propositions might you have? Yeah, totally. So for us, I think one thing that's interesting is we are Alchem based, which isn't a new model. But specifically for the pilots that we do with our customers, we offer an at-risk model. So what does that mean? So that means that, you know, like if we don't hit the metrics that we align on, whatever that may be, if the health system does not have dollars recovered or dollars identified to that aligned metrics that we set, you know, for us, we don't make any money ourselves. So the reason we do this is twofold. One, I think we're able to do this because we're confident in, you know, the value that we offer. And then two, it's also just to, you know, at its core align our incentives with our partners,

23:21the health system. So one thing that I've learned from starting my first company is it's always about your partners and the value deliver to them. So that's something that is just in the DNA of this company as well. Zenen, you're a super successful founder. We already talked about your first company where you exited it after a couple of years and now you started this new company. What are some of the keys do you think to your success? Yeah, that's a good question. I personally think there's still a very long way to go, but I would say being able to surround myself with sort of people who had similar interests and ambitions, I think being in an environment that's conducive to growing and constantly having a bar that's set is very helpful. I think even at, you know, when starting my first company, like one thing that one quote that I heard from someone

24:27that I think rings really true is that you should work with people even if they're your direct reports or your reports reports. You should work with people that make you feel a little uncomfortable in the sense that you in the sense that you just think that they're really, really good because that kind of pushes you to raise your bar as well. So that's something there. I think the other thing is just surrounding yourself with people who believe in you, who believe in your ambitions. Like obviously, you know, the more support you have, the more conducive it is to achieving goals that you may have. Yeah, it makes total sense. And speaking of which, is there one particular person in your journey that helped you see who you could be? Like, because, you know, it takes a little bit of moxie to do everything that you've done already. Who's that person that maybe like gave you the most juice to help you, you know, go the places that you've gone? Obviously, you know, the sort of expectations that my parents set for me growing up, like that, that sort of helped me have like

25:32really high ambition. I think, I think in terms of, in terms of starting my companies, it was definitely like our early investors. So, you know, from our first ever angel investor who invested in our first company two weeks in to founding, I think he was just amazing. Like in terms of the support he offered. And then why a commentator obviously, you know, there are early investors in so many great companies, but my partner there, he's just been amazing too from a company standpoint. And then lastly, it's just, you know, like all my friends, college to, you know, like professionally, I think just the people around me have been great to continuously push myself. Now I love that. There's been a great conversation. We talked, you know, from your unique name to growing up in Egladesh. And then, Psalms on your playlist, like we're going to add greatest showman

26:36the movie soundtrack to our Spotify playlist for digital voices. We talked about your life message mantra about keep going, having fun and being honest with yourself. And again, yeah, just you're very unique background. And then we talked about really both your companies that you've already, that you started, exited one, started the new one was Cesera and all the great things that you'll be able to do, helping kind of struggling hospitals become more profitable in a, in a, in a right way. And we talked a lot about leadership. Like what helped you become a leader you are. And some of the things that you talk about was like work with people, but not exactly like you, write that challenge you. And then people who've helped you. And you had a whole list of people, including your parents, the course and early investors. What did I miss? There's anything you want to double down on. I'll give you the last word. I think, I think that was pretty good. Yeah, we covered most things there. Yeah. Hey, it was great. Have a you on digital voices. And I know Cesera will be hugely successful. You're hitting a pain point that everyone struggles with. And I know based on

27:38your credibility from your, from your last company and your successful exit that there's no doubt that you'll hit it out of the park with, uh, with this company as well. So thank you for being our guest. Thank you for having me. Thank you for listening to digital voices. We hope today's conversation sparked ideas, reflection and connection. Subscribe on YouTube, Apple and Spotify podcasts so you don't miss an episode.